Andrew Vickers

Completely agree with your analysis. With respect to AUPRC, standard recommendation is to report discrimination, calibration and clinical utility (eg decision curve). AUPRC is a from of discrimination, so i guess you could report instead of AUC. But no-one has ever explained why you should.

Working on a paper on informed decision making for PSA screening. Looking for any literature demonstrating that PSA screening is a preference sensitive decision and / or any data that these preferences can be accurately elicited in primary care. Please advise.

Machine learning has developed remarkable new ideas about how to develop prediction algorithms. But always baffled me why the field had to reinvent how to evaluate models. Here we show F score should not be used to evaluate medical prediction models link.springer.com/epdf/10.1186...

Five things you need to know about prostate cancer diagnostic tests

Five things you need to know about prostate cancer diagnostic tests www.sciencedirect.com/science/arti...

Testing Whether Cancer Screening Saves Lives: Implications for Randomized Clinical Trials of Multicancer Screening - PubMed It is not feasible to test all-cause mortality when screening for an individual cancer. However, it is feasible to test all-cause mortality for multicancer screening because cancer deaths are such a large component of deaths in general. Observational data on the effects of cancer screening are misle …

For those who complained about the recent RCT on PSA not looking at overall mortality, note that Gil Welch, the well-respected screening skeptic, concluded "It is not feasible to test all-cause mortality when screening for an individual cancer"
pubmed.ncbi.nlm.nih.gov/37639251/

Magnetic Resonance Imaging or Confirmatory Biopsy for Patients With Prostate Cancer Receiving Active Surveillance This cohort study compares magnetic resonance imaging with confirmatory biopsy for patients with favorable-risk prostate cancer undergoing active surveilance.

MRI is a great tool in prostate cancer. The problem is, quality in practice might not be quality we see in studies. Nice study from @dr_coops showing that in the VA, MRI not good enough to rule out biopsy. jamanetwork.com/journals/jam...

RCT n= ~1500. >90% of patients walking through the door with target indication were randomized. Zero funding. Clinical integration and rethinking informed consent transformational. journals.lww.com/anesthesiolo...

Gosh, who could have predicted that the men who complained that they were being "censored!" during the pandemic phase of Covid (Prasad, Bhattacharya) are now leading the nation's health agencies & CENSORING others?

"staffers are terrified of pushing back on Prasad, lest they face retaliation"

Recently been debating "cancer screening skeptics" about endpoints in screening RCTs. They insist on overall survival (OS); when I point out feasibility issues, they say infeasibility of RCT on OS proves screening doesn't work. Prejudice masquerading as methodologic rigor.

Early Detection of Prostate Cancer — Time to Fish or Cut Bait | NEJM Approaches to early detection of cancer often seem contentious, but the big-picture view is actually one of remarkable consensus. All major guideline groups recommend the Papanicolaou smear, mammog...

Appreciated this editorial on the long term results from the prostate cancer screening trial. It's hard to believe we are doing the best we can be when it comes to this screening tool. Screening effectiveness needs to be re-evaluated over time as practices change.

www.nejm.org/doi/full/10....

I actually love this "trick". When we refused to do this analysis for an investigator, he complained to my boss, and then "fired" us as collaborators. Great! We never have to work with him again!

After my son’s team lost in semi-finals of frisbee nationals 2024, he wrote to team “I love you all. This is how we do better next year …”. 2025: national champions. Something for science to learn from the sporting world: respect and motivate your team and good things will happen.

Folks (Prasad etc) who say “cancer screening must improve overall survival”, let's take a real example, ovarian cancer. ~0.7% mortality; salpingectomy reduces risk by ≥50%. Trial could be powered on cancer mortality (n~20,000) vs. overall (n~750,000). Which would you recommend?

Whether / how to do PSA screening complex topic highly dependent on detailed knowledge. Plenty of room for reasonable disagreement. But I’m getting pretty tired of self-proclaimed skeptics who, without specialist knowledge, smugly condescend anyone supporting PSA as naive.

Very common to ask patients to rate pain from "no pain" (0) to "worst pain imaginable / possible" (10). Here is a randomized trial showing anchor for pain score of 10 should be "extreme pain" (TL;DR: we want to evaluate pain, not imagination) pmc.ncbi.nlm.nih.gov/articles/PMC...

Guidelines group argues against lymph node dissection in radical prostatectomy by cherry-picking outlying studies eg systematic review finds 5 studies on lymphedema only 1 with p<5%; authors cite that one study and ignore systematic review. www.europeanurology.com/article/S030...

Sepsis prediction not my field, but my anecdotal experience is that these models not well validated in the first place and don't work well in practice. Clinicians pick up on that and don't trust the model.

It is the power of ideology. Fight it.

UK woman who refused cancer drugs was influenced by mother, inquest finds Paloma Shemirani, 23, died after refusing chemotherapy for non-Hodgkin lymphoma despite doctors’ concerns

All wrapped up in a neat little bow. Covid conspiracy theorist encourages her lymphoma afflicted daughter to refuse chemotherapy. The daughter dies. The mother blames paramedics for the death. www.theguardian.com/society/2025...

Assessing the oncologic risk when systematic and multiparametric magnetic resonance imaging-targeted prostate biopsy grade groups are discordant AbstractBackground and Objective. In the systematic biopsy (SBx) era, prostate biopsy grading followed the rule that the ISUP grade group (GG) assigned was

Large multicenter study: "When grade group discordant between systematic & targeted biopsy, risk is intermediate. Current approach assigning highest grade should be abandoned ... consider de-escalating treatment when grade discordant." academic.oup.com/jnci/advance...

This has a long history: see Hofstadter on the paranoid style.

My theory of medical evidence is simple: observational studies for me, RCTs for you.

Prostate-specific antigen levels at age 60 and lifetime risk of lethal prostate cancer AbstractIntroduction. We investigated the natural history of the relationship between PSA at age 60 and lifetime risk of prostate cancer death in an unscre

Remarkable study from the Malmo Preventive Project: ~1000 men with blood at 60 in 1981; no PSA screening, *lifetime* follow-up. >50% life years lost to prostate cancer in PSA>4.0; 85% for PSA >2.0. Focus screening for men in 60s in men with higher PSAs! academic.oup.com/jnci/advance...

Now seen two papers claiming PLND not needed in a subgroup with relatively low incidence of positive nodes at radical prostatectomy. Neither cite the RCT showing benefit of PLND. When RCT says “do X”, don’t eyeball a case-series to conclude “don’t do X”.

yes, in the paper!

Most common pitfall: ignoring it entirely!

@richarddriley.bsky.social

Guidelines for Meta-analyses and Systematic Reviews in Urology Our guideline comprises points addressing the conduct and interpretation of systematic reviews and meta-analyses in urology. Application of the guideline would lead to a more considered interpretation...

This is big! Worked with great statisticians on guidelines for meta-analysis & systematic review. We discuss rationales for systematic review, evaluation & interpretation of heterogeneity, & common errors in network meta-analysis, funnel plots etc. www.europeanurology.com/article/S030...

exactly so! ANCOVA great for experimental, not always appropriate for observational. If your question is "does regimen A or B build strength faster?" and you e.g. randomized to A vs. B, your question is "if you started at a given strength level, would A or B make you stronger".

It is not about bias, it is about the question you are asking. ANCCOVA asks the question "would increases in strength from training be the same in men vs. women if it were true that men and women had the same strength at baseline?". I don't find that a very interesting question.